Why We Should Care for our Caregivers

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I write about making society healthier through education & healthcare

Author Note: Throughout this article the term “caregivers” broadly refers to anyone who provides care to someone else, including family caregivers as well as health professionals.

When I started medical school at Johns Hopkins I was the healthiest I had ever been up to that point, both physically and mentally. I had recently completed my first marathon and triathlon, forged two close friendships, and was genuinely excited about the journey ahead.

Six months later, I had gained 20 pounds, was ignoring calls from my friends and family, and was considering for the first time in my life whether to fill a prescription for an antidepressant.

What caused this rapid decline? Well, there were multiple factors like me deprioritizing my self-care routine, losing touch with friends and family, being unable to directly help patients, my worry about my growing student debt, and the unnecessarily competitive atmosphere. Fortunately, during my descent I stumbled across an influential study that was done just across the street, at the Bloomberg School of Public Health, that showed that clinicians who practiced healthy lifestyle behaviors were more likely to counsel their patients to do the same. This realization that my personal health would affect the health of my future patients had a profound influence on me and provided me the motivation I needed to reverse course.

In the months that followed, my medical school classmates and I created an oath called The Patient Promise which we signed along with thousands of other current and future health professionals and caregivers. We resolved to practice healthy lifestyle behaviors such as consuming a balanced diet, to make time for physical activity, to avoid harmful substances, and to take care of our mental health, not only for our own sake, but for that of our patients.

Although my personal health is better than when I had started medical school, in large part because of the development of seed habits, the general wellbeing and burnout levels of clinicians and caregivers has gotten worse. Last month Medscape released their annual National Physician Burnout, Depression, and Suicide report and found that 44% of the 15,000 physicians surveyed felt burned out, compared to 39% in their 2013 survey. Another study by Mayo Clinic researchers found a 9% increase in burnout among physicians from 2011 to 2014. Nearly 300 to 400 physicians commit suicide each year; that’s double the rate of the general population.

These reports have led the medical community to explore how early on in a clinician’s training burnout appears, and the results are not encouraging. A recently published systematic review found that the burnout level among the global medical student population is also around 44%, and another review found that 29% of residents were likely to experience a major depressive episode during training relative to 8% of similarly aged individuals in the general population. Likewise, a study of nearly 1,200 inpatient nurses found that the depression rate was twice that of the general population (18% versus 9%), which is remarkably similar to another study that found that 20% of employed female caregivers over 50 years old report symptoms of depression compared to 8% of their non-caregiving peers. Furthermore, 72% of family caregivers report not going to the doctor as often as they should, and 58% reported worse exercise habits relative to before they began their caregiving responsibilities.

As stewards of the public’s health, clinicians and caregivers need to be cared for as much as the rest of us.

www.osmosis.org

With the increasing demand for clinicians and caregivers due to the aging population, it’s critical to understand and address the systemic and individual factors that are leading to burnout and its consequences such as professional turnover. There are at least three consequences we should be paying careful attention to:

Consequences for the Caregiver. The burnout and depression rates among clinicians and caregivers appear to be increasing and can lead to, at best, absenteeism and at worst suicide. Our care providers are not just cogs in our healthcare system meant to help us when we need, but rather individuals with their own wants and needs.

Consequences for the Patient.At the beginning of a flight, the flight attendant always reminds us to “put the oxygen mask on yourself before helping anyone else.” This intuitively makes sense: How can you help anyone else if you’re incapacitated? Several studies have shown that burnout and emotional exhaustion can be significant predictors for major medical error, malpractice lawsuits, health care-associated infections, patient satisfaction, and even patient mortality ratios. Furthermore, as mentioned above, clinicians who practice what they preach are more likely to be able to counsel and influence their patients to adopt healthier lifestyle behaviors. As the famous physician and Nobel Laureate in Peace, Albert Schweitzer, said, “Example is not the main thing in influencing others. It is the only thing.”

Consequences for the Healthcare System.The effects of burnout on the care provider and patient cascade into consequences for the overall healthcare system. For example, staff turnover can cost health care organizations hundreds of thousands of dollars per provider to replace. In addition, a longitudinal study of physicians showed that a 1-point increase in emotional exhaustion or 1-point decrease in job satisfaction was associated with a 28 and 67 percent, respectively, greater likelihood in reducing work hours the following year, which puts a strain on an already overburdened clinical workforce. While the Association of American Medical Colleges has been calling for increased enrollment at medical schools to keep up with demand. The reduction in productivity due to emotional exhaustion at the national level is estimated to be the equivalent of losing seven graduating classes of medical students per year.

Leading medical organizations such as the National Academy of Medicine and Accreditation Council for Graduate Medical Education are paying close attention to the above issues and, in response, developed an Action Collaborative on Clinician Well-Being and Resilience. It is encouraging to see how many organizations, ranging from the American Nurses Association to Aetna, have joined the collaborative because the complexity of the problem will require a diverse set of solutions ranging from the individual to the systemic levels.

Focusing on the well-being and resilience of caregivers will have a compounding effect and reap dividends for public health, not only because of improved productivity and quality of care but also because of the diffusion of coping strategies such as physical activity, mindfulness, and healthy eating from caregiver to patient.